Carl Court

This service was last inspected in July 2016 and was rated good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Carl Court is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

There were 14 people living in the home at the time we carried out our inspection.

The registered providers were also the registered managers at the home and they were responsible for the day-to-day management of the service. This report refers to them as the providers. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Without exception, everyone we spoke with expressed positivity about Carl Court, providing evidence of the home’s ability to make them feel cared for and safe. People were treated with kindness and respect and were offered care in a dignified manner in caring surroundings. One person said, “I feel very well cared for. My room is lovely and clean, and the carers always have time for me.” Relatives told us they felt totally comfortable and happy with the care at Carl Court. One relative said, “We love it. When we arrived [providers name] greeted us at the door and said, ‘welcome home.’ And that’s what it is, a home.”

People, relatives and staff told us they felt the home was well led and the providers were passionate, accessible and approachable. The providers had a good oversight of what was happening in the home and demonstrated an in-depth knowledge of all areas. Systems were in place to audit the quality of the service. However, some processes needed to be strengthened to ensure that all aspects of the home were maintained and regularly reviewed. We made a recommendation to the providers to review their governance systems.

Risks to people's safety and wellbeing had been assessed and planned for. Risk assessments identified what support was needed to reduce and manage risk. However, some risk assessments were not up dated as they should or when things changed. We made a recommendation to the providers to review care records to ensure all risks have been assessed and are up to date.

People had their needs assessed before they moved into the home and this information was used to create individual care plans. These plans included guidance for staff to follow to ensure people's individual needs were met. Whilst some care plans provided staff with guidance on how to support people safely as well as providing information on people's preferences, we found that some would benefit from further person centred information. We made a recommendation to the providers about developing person-centred care plans.

Staff understood their responsibility in protecting people from the risk of harm. People were assisted by suitable numbers of staff who were trained and supported in their job roles. Staff had been safely recruited and had received an induction to the service.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People told us they enjoyed the food. People's dietary and nutritional needs were assessed, recorded and managed and advice was sought from nutrition specialists when needed. People had support to access professional medical advice and treatment and attend routine medical appointments. Health professionals were extremely complimentary about the care at Carl Court.

The home was clean and had all required health and safety checks and documentation in place. Equipment was regularly serviced, and fire checks were regularly undertaken within the home. Individual emergency evacuation plans were in place for people.

The providers had a clear complaints policy that people and their relatives knew how to access. People told us they felt confident to raise any concerns they had and felt they would be promptly addressed.

Further information is in the detailed findings below.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

One person said; “I feel safe here.” A survey recorded; “We continue to feel fortunate my mother was able to find a home at Carl Court.” A professional said they’d happily let their relative live in the service.

People were engaged in different actvities and were enjoying the company of the staff. There was a calm and relaxed atmosphere within the service. Comments included; “They (the staff) are very accommodating.” A survey returned to the home said; “Thank you for the wonderful care you consistently provide.” People said they were happy living at the service.

People were happy with the care the staff provided. They agreed staff had the skills and knowledge to meet people’s needs. People were encouraged and supported to make decisions and choices whenever possible in their day to day lives.

People had their privacy and dignity maintained. Staff were observed supporting people with patience and kindness.

People were protected from harm as staff had completed safeguarding of vulnerable adults training. Staff had knowledge of how to report any concerns and what action they would take to protect people. The registered manager and registered provider, who worked in the service most days, had taken action where they thought people’s freedom was being restricted. Applications were made and advice sought to help safeguard people and respect their human rights.

People were protected by safe recruitment procedures. Staff were supported with an induction and ongoing training programme to develop their skills, and staff competency was assessed. People said there were sufficient staff on duty.

People had visits from healthcare professionals. For example, GPs and district nurses, to ensure they received appropriate care and treatment to meet their health care needs. Professionals confirmed staff followed the guidance they provided. People received the care they needed to remain safe and well. For example, people had regular visits by district nurses to change dressings.

People’s medicines were managed safely. Medicines were stored, and disposed of safely. Senior staff administered medicines, they confirmed they had received training and understood the importance of safe administration and management of medicines.

People who did not have capacity to make decisions for themselves were supported by staff to make sure their legal rights were protected. Staff worked with other professionals in people’s best interests.

People were supported to maintain a healthy balanced diet. People told us they enjoyed their meals and there was plenty of food available. We observed people, who required it, being supported at mealtimes. One person said; “Food is very good, excellent.”

People’s care records were of a good standard, were detailed and held people’s preferences.

People’s risks were considered, well-managed and regularly reviewed to keep people safe. Where possible, people had choice and control over their lives and were supported to engage in activities. Records were updated to reflect people’s changing needs. People and their families were involved in the planning of their care.

People and staff described the registered manager and registered provider as approachable, available and supportive. Staff talked positively about their jobs and took pride in their work. Visiting professionals and staff confirmed the registered manager and registered provider made themselves available and were very good at supporting them.

The registered manager and registered provider had an ethos of honesty and transparency. This reflected the requirements of the duty of candour. The duty of candour is a legal obligation to act in an open and transparent way in relation to care and treatment.

People’s opinions were sought formally and informally. There were quality assurance systems in place. Feedback was sought from people and their relatives to assess the quality of the service provided. Audits were conducted to ensure the quality of care and environmental issues were identified promptly. Accidents and safeguarding concerns were investigated and, where there were areas for improvement, these were shared for learning.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

We spoke with three people using the service, and they each told us they were happy living there and with the support they received from staff. One told us "I have a key worker with whom I can talk to, she knows me well." They added "It feels like home here and really couldn't be any nicer."

People we spoke with confirmed that they felt safe and supported by staff. They had no concerns about the ability of staff to respond to any of their concerns should they arise. We observed a relaxed atmosphere, where people were happy in their surroundings and with staff supporting them.

One relative told us "I have no concerns but if this was not the case, I would feel confident that the matter would be dealt with promptly."

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards which applies to care homes. The Deprivation of Liberty Safeguards is in place to protect people's human rights. The manager said they had not needed to submit a Deprivation of Liberty Safeguards application to-date. However, the manager was aware when an application should be made and knew where to go if an application was required.

Is the service effective?

People were encouraged to remain independent. Care plans identified what people were able to do for themselves, rather than only focusing on what a person could not do. For example, care plans had details such as 'The person is able to make daily life choices.' The plans then listed the things the person could do for themselves, such as picking out their own clothes and attending to their own personal care.

One person told us "When I first met with the manager I discussed what my needs were and we spoke about how I would fit into the home. I'm more comfortable here and have made friends."

People told us that they felt respected and involved in the planning of their care right from the start. One person said "I am happy here, they support me with my independence." Another said "I'm very happy here, it suits me down to the ground."

Is the service caring?

People were treated with dignity and respect. We saw that staff were courteous when interacting with people. Staff called people by their preferred names and these had been recorded in care plans. We saw that people were able to return to their rooms during the day if they choose to, and were able to get up later in the day if they so wished.

One person told us "They are all very kind and couldn't do any more for me. I have my own room, with my belongings this is my home and I'm very well cared for." They added that staff are also welcoming to friends and families visiting the home. "I go out once a week with friends and they are happy for me to have a later lunch if needed."

One relative told us "It was only by chance that the home had a vacancy at the right time for our family member. It's the only good thing that has come out of all our difficulties is to have them here. It's such a relief to see them happy and well cared for."

Is the service responsive?

Relatives told us that they had visited the service before their family member had come to stay. They were shown around and were able to ask questions and given information about the care and choices that were available.

We spoke with three people who lived in the home. They told us they were able to make their own daily living choices such as meal choices and activities. One person told us "I can do exactly what I wish to do each day and at meal times just have what I fancy."

Close links were evident with other professionals such as a GP, hospital and dentist. It was evident that the home regularly sought the support of relevant professional advice. This showed that staff were given information to enable them to provide care that met people's specific needs. We saw that daily care notes had been recorded. These showed that care was provided as had been detailed in the plan. From our observations care and attention had been given to people's hygiene and dress needs.

People who used the service and their representatives were annually asked for their views about their care and treatment and they were acted on. We saw that people had completed the survey and positive comments had been made. This meant that people who used the service had an opportunity to have their say.

Is the service well led?

Both Registered Managers we met with demonstrated a good awareness of the needs of the people that lived in the home and looked at good practice guidance in order to improve care provided. We saw that home sought professional advice when needed and this was in the best interests of the people who lived in the home. Decisions about care and treatment were made by staff at an appropriate level.

One relative added "We continue to feel fortunate that our family member was able to find a home at Carl Court, every effort is made to provide a safe, warm environment of a very high standard and is a credit to both the management and staff."

The manager operated an 'open door' policy which meant staff, residents and visitors were welcome to talk with them at anytime. They were frequently within the home and often worked alongside staff. During our visit we observed the care manager working closely supporting staff and people. People told us how highly the staff and residents rate the care given by the management. "They are wonderful people, who go out of their way to make this a special home."

The manager was knowledgeable about all the people in their care, and spoke warmly and sincerely about the people using the service. We observed interactions with people were patient and respectful. There was a relaxed and friendly atmosphere in the service that people responded favourably to.

One staff member added "The manager always listens to what we say, to put forward ideas to the benefit of the residents."

Most people had lived at Carl Court for some time and knew each other and the care workers well. People had clear assessments of their needs and plans and strategies were in place to meet them. People's care plans had been reviewed regularly.

We saw that care workers interacted with people in a relaxed and respectful manner. People had made friendships within the home and had access to social activities. One person said 'I go out walking with my two friends'.

During our visit we saw that people were offered choices throughout the day which supported their independence and provided a meaningful quality of life. Regular activities were organised by the provider and people told us that they enjoyed them.

Care workers were skilled and experienced and had worked at the home for many years. Care workers had received training in safeguarding vulnerable adults and recognising abuse and knew how to report any concerns.

We saw evidence that a robust recruitment procedure was in place. We found that the provider dealt with complaints swiftly and to the satisfaction of the residents.